This website provides information on how Atos runs its business,
extracts from the Contract between the DWP and Atos including the
MEDICAL CONDITIONS
that mean a face to face medical assessment is not always necessary,
ASSESSMENTS AND POINTS,
the breaches of Contract that occurred in my case, my unsound medical report
and the correspondence showing how difficult it is to obtain justice or advice.

Employment and Support Allowance

This page contains extracts of the information that I provided in the
ESA50 form.
It contains the unsound medical advice ESA85 form
that Atos Healthcare provided to the DWP Decision Maker.
It contains the breaches of Contract
that occurred in my case.

The "medical" examination was undertaken on 24 July 2009.
It should have started at 15:30 and started 45 minutes late.
After many letters and emails, including two letters to the
Secretary of State for Work and Pensions, a printed copy of the ESA85 advice
to the DWP Decision Maker was received on 25 November 2009.
This came without a cover letter.
It is not yet clear whether this is an authorised copy or not.

The facts and observations are disputed.

Lack of Quality in the ESA85 Advice

Please note the grammar, spelling and tardiness.
This is supposed to be a professional document.
I do not accept errors such as using "She" instead of "He"
is ever acceptable.
I do not accept the use of the plural form "their" when
"his" should be used.
Professional documents should be checked and rechecked
especially where life, death and finances are involved.

Atos Healthcare are happy with the quality and
professionalism of the "Registered Medical Practitioner"
who produced this report as they passed it to the DWP.

It should be noted that the phrase "side affect" is used
when the phrase "side effect" should have been used.
There has been a recent medical case when notes were passed
from one doctor to another, who took over as part of a shift change,
and effects were misreported as affects with fatal consequences.

The following sentence might enlighten.

"Her poor performance did not affect me at the time because
I knew the incompetence of Atos Healthcare personnel
would have had no effect on my
prior decision to keep accurate records.

It is surprising as a layman that so much medical information
can be gleaned in a 10 minute examination.
I would not accept this in my field of expertise
and find it more difficult to accept in the field of medicine.
I found the "Registered Medical Practitioner" had
difficulty with spoken English.
She did not know what intermittent meant and so did not include
the word in the report. I do think it is important to record
whether a symptom is constant or intermittent.

I was amazed at the sweeping conclusions that
this "Registered Medical Practitioner"
felt able to make.
None of the specialist consultants who have seen me
can state when my condition started and yet this
"Registered Medical Practitioner" can boldly state on page 2
"The condition started 8 years ago".

As an engineer, I am not the best qualified to comment on grammar.
Nevertheless there are tools, such as grammar check, which can be useful.
I suggest this is another example of the inferior quality of the
IT Services supplied by Atos Healthcare.

ESA50 10/08 Limited Capability for work Questionnaire

The following is an extract of the information
that I provided and which was stamped as being processed
15 June 2009. It took days to complete by hand as I was
shaking and twitching. The hand writing is very poor despite
the force of will to stop the shakes.

About You

...any special help you would need if you go for a medical
assessment.

My ant-fit medicine makes me very tired.
My right knee fails at times so I use a stick for support.
There is no transport from H... to Q... Hospital
which is the closest place for neuro-surgery.
If I am strong, I can use public transport to go to Q... Hospital.
My wife takes me to my local hospital.

Tell us about any times or dates in the next 3 months
when you cannot go to a medical assessment.

It is getting worse symptoms worse 10
days ago so follow up MRI scan moved earlier.

Can you sit in a chair?

Yes

Can you stay sitting on a chair...

Yes

Can you get up from a chair...

Yes

Can you move from one seat to another right next to it...

Yes

3. Bending and Kneeling

4. Reaching

Sometimes not right as tumour on left.

5. Picking up and moving things on the same level

Can you pick up and move a litre (two pint) carton full of liquid...

It varies

Can you pick up and move a half-litre (one pint) carton full of liquid...

It varies

Use this space to tell us more about picking things up...

Right weak as tumour on left of brain.

Can you use both hands together to pick up and move something
big but light, like an empty cardboard box?

Yes

6. Manual Dexterity (Using your hands)

Can you use your hands to do things like ...

It varies

Use this space to tell us more...

Handwriting poor getting worse as right handed
and tumour on left of brain.

7. Speech

Can you speak?

Yes

If yes, can you speak clearly enough for a stranger...

Yes

Use this space to tell us more...

Slur sometimes.

8. Hearing

Can you hear?

Yes

If yes, when someone is talking to you in a busy a street,
can you hear what they are saying?

It varies

Use this space to tell us more...

Tumour related.

9. Seeing

Do you have any useful sight?

Yes

Can you see well enough to recognise a friend 15m (just
over 15 yards) away ...

Yes

Do you have any other problems with your eyesight?

It varies

Use this space to tell us more...

Tumour related.

10. Controlling your bowels and bladder

11. Staying consious when awake

While you are awake, do you have fits or blackouts?

Yes

If you have a problem with fits or blackouts, do
you get a warning that it is going to happen?

Sometimes

Use this space to tell us more...

Anti-fit medicine was doubled 10 days ago. Emergency MRI Scan.

Part 2 - Mental, cognitive and intellectual functions

12. Learning or comprehension in the completion of tasks

Can you learn how to do a simple task as long as someone shows you
what to do?

Usually

Can you understand and remember how to do a more difficult task?

Usually

13. Awareness of hazard or danger

Can you manage your daily life safely?

Usually

14. Memory and concentration

Can you remember to do your usual daily routine?

Usually

Can you concentrate on your daily routines?

Usually

15. Execution of tasks

Do you have difficulties finishing routine daily jobs?

It varies

Use this space to tell us more...

Not if too tired (most mornings).

16. Initiating and sustaining personal action

Can you organise yourself to start and keep on with routine jobs?

It varies

Do you need encouragement...

It varies

Use this space to tell us more...

Tumour related.

17. Coping with change

18. Going out

19. Coping with social situations

20. Propriety of your behaviour with other people

21. Dealing with other people

Other information

My symptoms got worse 10 days ago.
Consultant wanted me to be emergency admitted.
GP agreed I could be treated at home as H... hospital can do nothing
for me except treat symptoms.
Doubling anti-fit has treated problems for now.
Will receive analysis of MRI scan next week.

....too tired

12% survive 5 years. I am not optimistic
(question to Parliament 2007 about Primary Brain Tumour)

...I am 52. I have had a reasonable innings.
The doctors and hospitals have been excellent.

If you need more, talk to them or ring me if I am
strong enough to answer.

ESA85 Medical Report Form

The printed report was scanned as images, converted to text
and sensitive information removed.
There have been minor format changes to improve the layout.
This is a true copy of the actual report.

Page 2 of 26

Client InterviewMedical Conditions and Treatment1. Medical ConditionsConditions Medically Identified
Brain Tumour
Cardiovascular Problem
Other Conditions Reported
Client states no other problems
2. Medication
Levetiracetam 500 mg
Atenolol (for blood pressure taken regularly.
Ramipril (for vascular disease) taken regularly.
Simvastatin (for cholesterol) taken regularly.
3. Side Effects Due to Medication
The client experiences drowsiness as a result of their epilepsy medication.
4 Description of Functional Ability
Having considered whether the condition is likely to vary during the average week
and if the function can be carried out regularly and repeatedly taking into account,
fluctuation, pain, fatigue, stiffness, breathlessness, balance problems etc,
the description of functional ability is as follows:
Condition HistoryBrain Tumour
The condition started 8 years ago.
He was unconscious for 20 minutes, he had grand mal fit with big pain.
Last admitted to ... hospital 3 months ago. Stayed in hospital for 10 days.
He was put in stroke unit with symptoms of stroke.
Has had MRI scan for Brain Tumour and the result confirmed an abnormality.
Since October 2008 he had 4 fits including 4th in April when he was admitted to hospital.
I past 6 months 3 fits.

Page 3 of 26

Description of Functional Ability
He had to submit his driving license.
She suffers with fits, cramps, problem with walking, balance, shaking,
visual problems, tiredness, migraines and anxiety.
He was put on anticonvulsive treatment.
Currently attends the neurosurgeon out-patient clinic at ... hospital every 3 months.
The treatment started 3 months ago.
He was offered immediate surgery, watch and see or biopsy with radiation.
They decided to wait and see.
He had another MRI scan 10 June and there was no change.
He is referred to neurologist.
Sees GP at the surgery for this condition.
Cardiovascular Problem
The condition started 8 years ago.
It has been getting worse over the last 3 years.
Troubled by headaches and lightheadedness which happens most days.
Sees GP at the surgery every 1 month for routine check up for this condition.
Social History
The examination was carried out in an examination centre.
Came by tube here today, which took about 119 minutes.
Came to the examination centre alone.
Lives with their wife.
Lives in a house.
Occupational History
Last occupation: IT manager.
Stopped work 10 months ago.
The main reason for leaving work was redundancy.
Not currently working or studying,
The client is right-handed.
Description of a Typical Day
Client states that:
Usually gets up at about 6 am.
Usually sleeps well.
Usually needs to lean on something to get out of bed due to pain and stiffness.
Usually goes to bed at about 10 pm.
Poor sleep at night causes moderate fatigue and napping during the day.
Has no problems in the bathroom.
Has no problems with dressing.
Often needs someone's help to make meals due to weakness and poor concentration.

Page 4 of 26

4. Description of Functional Ability
Usually able to use kettle, use oven and use microwave.
Usually able to do housework for about 15 minutes.
Climbs and descends the stairs every day by holding on to the rail.
Always unable to go to the local shop, alone or with someone else because of weakness,
poor balance and blackouts.
While taking the anticonvulsive medicine 1 hour later as a side affect he feels
extremely tired.
Able to walk 100 metres at a slow pace to the shops occasionally.
Can travel as a passenger without significant difficulties.
Experience no difficulties queueing.
Usually has difficulty using a computer for web surfing due to their poor concentration.
Listens to music most days.
Reads books most days.
Usually finds taking part in leisure activities such as watching TV difficult,
due to their problem with mood disturbance.
Usually has difficulty doing light gardening due to their poor balance.
The client speaks to their friends most days,
Has no difficulty communicating with others.
Is usually able to use a mobile phone for keeping in touch with others.
Always unable to deal with own correspondence due to upper limb problem and poor dexterity.
Requires help from wife.
Always able to begin and continue to complete getting washed and getting dressed
without any help.
Has not suffered any serious accidents or near misses recently.
Does not drink alcohol.
Is able to manage any changes in their daily routine and continue their day to day activities.
Experiences no difficulties finding their way to both a familiar and unfamiliar location.

Page 5 of 26

Medical Opinion - Physical
I have considered the possible ESA activity outcomes and my advice is that the following apply:
Lower limb - Activity OutcomesActivity 1 - Walking with a walking stick or other aid if such
aid is normally used
We - Cannot walk more than 200 metres on level ground without stopping
or severe discomfort
Activity 2 - Standing and Sitting
Sg - None of the above apply
Activity 3 - Bending or Kneeling
Bd - None of the above apply
Lower Limb - Supporting Medical Evidence5. Prominent features of functional Ability Relevant to Daily Living
Client states that:
Has no problems in the bathroom.
Has no problems with dressing.
Usually able to use kettle, use oven and use microwave.
Usually able to do housework for about 15 minutes.
Climbs and descends the stairs every day by holding on to the rail.
Always unable to go to the local shop, alone or with someone else because of weakness,
poor balance and blackouts.
Able to walk 1OO metres at a slow pace to the shops occasionally.
Usually has difficulty doing light gardening due to their poor balance.
6 Behaviour Observed During Assessment
Client was able to sit on a chair with a back for 65 minutes.
The client rose twice from sitting in an upright chair (with chair arms) without
physical assistance from another person.
The client was able to bend to the floor and get up again to pick up an item
without assistance.
Stood independently for 5 minutes without difficulty.
The client walked 35 metres normally to the examination room.

Page 6 of 26

6 - Behaviour Observed During Assessment
Gait observed to be broad-based and I found this consistent.
Was able to get onto the couch without assistance,
Did not appear to have any difficulty using a step to get onto the couch.
7. Relevant Features of Clinical Examination
Abnormal Findings: Relevant Normal findings:
Right Leg
Power in the right leg was slightly reduced
Reasons for loss of function: Pain, Stiffness,
Neurological Problem
Blood Pressure
Slightly raised sitting blood pressure
Other findings:
No other significant findings from the lower limb examination noted.
No other significant findings from the cardiac examination noted.
No other significant findings from the vascular examination were noted.
8. Summary of Functional Ability
Examination findings suggest mild disability due to functional loss of the lower leg,
which is consistent with the typical day and observations.

Page 7 of 26

Upper Limbs - Activity OutcomesActivity 4 - Reaching
Re None of the above apply
Activity 5 - Picking up and moving or transferring by the use
of the upper body and arms
Pd None of the above apply
Activity 6 - Manual Dexterity
Mj None of the above apply
Upper Limbs - Supporting Medical Evidence9. Prominent Features of Functional Ability Relevant to
Daily Living
Client states that:
Has no problems in the bathroom.
Has no problems with dressing.
Usually able to use kettle, use oven and use microwave.
Usually able to do housework for about 15 minutes.
Always unable to go to the local shop, alone or with someone else because
of weakness, poor balance and blackouts.
10. Behaviour Observed During Assessment
Had difficulty with removing coat but was able to manage unaided.
11. Relevant features of Clinical Examination
Abnormal Findings: Relevant Normal Findings:
Right Upper ArmNeck
Muscle power in the right arm is significantly No neck tenderness
reduced No grating felt on neck movements
Reasons far loss of function: Pain, Stiffness, Can touch chin to front of chest
Neurological Problem Full upward neck movement
Can look over left shoulder
Can move left ear towards shoulder
Can look over right shoulder

Page 8 of 26

11. Relevant features of Clinical Examination
Can move right ear towards shoulder
Left Upper Arm
Left shoulder turns outwards normally
Can put left hand fully behind neck
Left hand can reach fully behind back
Can raise left arm away from side as normal
Can fully bend left elbow
Muscle power in the left arm was normal
Right Upper Arm
Right shoulder turns outwards normally
Can put right hand fully behind neck
Right hand can reach fully behind back
Can raise right arm away from side as normal
Can fully bend right elbow
Muscle tone in the right arm was normal
Left Forearm
Left wrist turns inwards as normal
Left wrist turns outwards as normal
Left wrist bends backwards as normal
Left wrist bends forwards as normal
Left hand - thumb and index finger grip normally
Left fist grips normally
Right forearm
Right wrist turns inwards as normal
Right wrist turns outwards as normal
Right wrist bends backwards as normal
Right wrist bends forwards as normal
Right hand - thumb and index finger grip normally
Right fit grips normally
Other Findings:
No other significant findings from the upper limb examination were noted.
12. Summary of Functional Ability
The client's Brain Tumour is mild. They have seen a specialist for this problem.
The medication used is average strength.

Page 9 of 26

Vision, Speech, Hearing - Activity OutcomesActivity 9 - Vision including visual acuity and visual fields, in normal daylight
or bright electric light, with glasses or other aid to vision if such
aid is normally worn
Vg None of the above apply
Activity 7 - Speech
SPe None of the above apply
Activity 8 - Hearing with a hearing aid or other aid if normally worn
He None of the above apply
Vision, Speech, Hearing - Supporting Medical Evidence13. Prominent Features of Functional Ability Relevant to Daily Living
Client states that:
Has no problems in the bathroom.
Usually able to use kettle, use oven and use microwave.
Usually able to do housework for about 15 minutes.
Usually has difficulty using a computer for web surfing due to their poor concentration.
14. Behaviour Observed During Assessment
Had no difficulty negotiating doorways and furniture within the examination centre.
Had no difficulty reading small print on medicine label and a letter.
15. Relevant Features of Clinical Examination
Visual acuity was 6/6 using both eyes with glasses.
Visual field testing was normal in both eyes.
16. Summary of Functional Ability
There was no evidence of significant physical disability affecting vision from the
condition history, typical day history, physical examination findings, observed
behaviour and medical knowledge of the condition.

Page 10 of 26

Continence (Other than Enuresis) - Activity OutcomeActivity 10a - Continence other than enuresis (bed wetting) where the person does
not have an artificial stoma or urinary collecting device
Ch None of the above apply
Continence - Supporting Medical Evidence19. Summary of Functional Ability
Client has no problem with this activity.

Page 11 of 26

Consciousness - Activity OutcomeActivity 11 - Remaining conscious during waking moments
Fc At least twice in the six months immediately preceding the assessment,
has had an involuntary episode of lost or altered consciousness, resulting
in significantly disrupted awareness or concentration
Consciousness - Supporting Medical Evidence20. Prominent Features of Functional Ability Relevant to Daily Living
Client states that:
Always unable to go to the local shop, alone or with someone else because of weakness,
poor balance and blackouts.
Has no problems in the bathroom.
Able to walk 100 metres at a slow pace to the shops occasionally.
Had to give up driving due to problems with fits.
21. Relevant Features of Clinical Examination
Neurological examination revealed moderate weakness in the right leg.
22. Summary of Functional Ability
The customer's fit result in infrequent episodes of altered consciousness during
waking hours, which result in significantly disrupted awareness or concentration.
They have seen a specialist for this problem. The medication used is average strength.
The client's medication does improve their level of function.

Page 12 of 26

Medical Opinion - Mental, Cognitive and Intellectual FunctionUnderstanding and Focus - Activity OutcomesActivity 12 - Learning or comprehension in the completion of tasks
LTf None of the above apply
Activity 13 - Awareness of Hazard
AHd None of the above apply
Activity 14 - Memory and Concentration
MCc Frequently forgets or loses concentration to such an extent that overall day to day
life can only be successfully managed with pre-planning, such as making a daily
written list of all tasks forming part of daily life that are to be completed.
Activity 15 - Execution of Tasks
ETe None of the above apply
Activity 16 - Initiating and sustaining personal action
IAe None of the above apply
Understanding and Focus - Supporting Medical Evidence23. Prominent features of Functional AbiIity Relevant to Daily Living
Client states that:
Has no problems in the bathroom.
Usually able to use kettle, use oven and use microwave.
Usually able to do housework for about 15 minutes.
Always able to begin and continue to complete getting washed and getting dressed
without any help.
Has not suffered any serious accidents or near misses recently.
Experiences no difficulties finding their way to both a familiar and unfamiliar location.
Usually has difficulty using a computer for web surfing due to their poor concentration.
Always unable to deal with own correspondence due to upper limb problem and poor
dexterity. Requires help from wife.

Page 13 of 26

24. Relevant Features of Clinical Examination
Abnormal findings: Relevant Normal Findings:
Appearance
Looks tired
Behaviour
Was restless
Cognition - General
Needing prompting at interview
Poor concentration on examination
25. Summary of Functional Ability
Mental state examination suggests the client's Brain Tumour causes mild disability
with their concentration, which is consistent with the condition history,
typical day history and medical knowledge of the condition.

Page 15 of 26

Social Interaction - Activity OutcomesActivity 20 - Propriety of Behaviour with Other People
IBg None of the above apply
Activity 21 - Dealing with Other People
DPg None of the above apply
Social Interaction - Supporting Medical Evidence31. Summary of Functional Ability
Client has no problem with these activities.

Page 16 of 26

Exceptional CircumstancesNon-Functional Descriptor
The Non-functional descriptors were not considered for this case as curtailment applied.

Page 17 of 26

Limited Capability for Work-Related Activity34. Evidence to support the opinion that the person does not meet any of the descriptors
for limited capability for work-related activity
Terminally Ill:
There are no conditions reported that are likely to result in death within 6 months.
Chematherapy:
From the available evidence, the client is not receiving or recovering from chemotherapy
administered via an intravenous, intraperitoneal or intrathecal route.
Pregnancy Risk:
Male client.
Substantial Mental or Physical Risk:
There is no indication of any condition that would lead to a substantial mental
or physical risk if the client were found capable of work related activity.
Watking or moving on level ground:
Although the client has some limitation walking, the history, examination,
observed behaviour and medical knowledge of the condition suggest they would be
able to walk more than 30 metres.
Rising from sitting and transferring from one seated position to another;
The evidence does not support that the client has a significant problem rising
and transferring, therefore they should be able to rise from sitting and transfer
themselves independently.
Picking up and moving or transferring by the use of the upper body and arms,
reaching and manual dexterity:
The evidence does not support that they suffer from a physical condition severely
affecting the trunk or upper limb function. Therefore, they should be able to use
a star-headed tap, reach up to the top pocket of a coat or jacket, pack up
and move a O.5 litre carton full of liquid and pick up a £1 coin or equivalent.
Continence where the client does not have an artificial stoma or urinary device:
The evidence does not support a significant continence problem, therefore it is
unlikely the client would lose control every week of full bladder emptying or
full bowel evacuation.
Maintaining personal hygiene:
The evidence indicates that the client's physical and mental function is at a level
which would allow them to clean the front of their own torso independently.
Eating and drinking:
The evidence does not support that the client cannot eat and
drink independently.
Learning or comprehension in the completion of tasks and personal action:

Page 18 of 26

34. Evidence to support the opinion that the person does not meet any of the descriptors
for limited capability for work-related activity
The evidence does not support that there is either a severe mental health problem or
impairment of cognitive ability which would prevent the client being able to learn
or understand how to undertake a simple task, or to initiate and sustain basic
personal action.
Communication:
There is no evidence to support that the client has significant difficulty interpreting
or using any of the usual forms of communication.

Page 19 of 26

Prognosis35. Expected Change
Functional Problems:
I advise that a return to work could be considered within 6 months.
36. Reasons for the Opinion Given
The client's level of disability would be expected to improve with time and
appropriate treatment.

Page 25 of 26

44. Mental 5tate
Concentration: Poor
Insight
Insight: Good
Awareness of Danger: Adequate
No other significant findings from the mental state examination were noted.
45. Observed BehaviourLower Limb & Back
Client was able to sit on a chair with a back for 65 minutes.
The client rose twice from sitting in an upright chair (with chair arms)
without physical assistance from another person.
The client was able to bend to the floor and get up again to pick up an item
without assistance.
Stood independently for 5 minutes without difficulty.
The client walked 35 metres normally to the examination room.
Gait observed to be broad-based and I found this consistent.
Was able to get onto the couch without assistance.
Did not appear to have any difficulty using a step to get onto the couch.
Upper limb
Had difficulty with removing coat but was able to manage unaided.
Sensory
Had no difficulty negotiating doorways and furniture within the examination centre.
Had no difficulty reading small print on medicine label and a letter.

Page 26 of 26

Declaration
This form has been completed by a healthcare professional approved by the
Secretary of State for Work and Pensions.
I have completed this form in accordance with the current guidance to
ESA examining healthcare professionals as issued by the Department for Work
and Pensions.
I can confirm that there is no harmful information in the report other than indicated.
Healthcare Professional's Name Dr Ludmila Semetillo (Registered Medical Practitioner)
Approved Disability Analyst
Date 24 July 2009

Contract and My Case

Introduction

The Contract provides strong evidence that, in my case, Atos Healthcare
has both acted illegally and have on a number of occasions been in
breach of the Contract. In breaking the law, in my case, Atos Healthcare have
claimed that they have acted "in good faith".
In my view the illegal actions of Atos Healthcare has caused me actual harm,
the advice Atos Healthcare gave to the DWP is a libel and
has caused the DWP to apply a procedure that has caused me further harm.
Atos Healthcare have been given many opportunities to put
right the harm they have caused. They have, as yet, not chosen to do this.
My rights as a patient have not, as yet, been protected by the DWP.

Atos Healthcare and the company SEMA under which they previously traded
has been used by the DWP to supply healthcare services since 2000 and before.
If you feel Atos Healthcare has acted illegally or has been in breach of the Contract
you should contact the DWP in the first instance and then your MP for redress.
You may be entitled to compensation from Atos Healthcare.
The DWP are legally obliged to ensure that the Contract is complied with.
Even if you feel you have obtained the correct result but you do
not know if a qualified medical advisor was used to decide on whether
a face to face meeting was necessary, you should find out from Atos Healthcare.
Many are sick and unable to do this but if you can, please find out from
Atos Healthcare if not for yourself but then for others less fortunate than you.

Where does it say the assessor should be qualified?

You should email to Atos requesting in writing who decided that a face to
face assessment was necessary and the medical reasons for the
face to face assessment. Point out you may wish to check with the GMC
prior to the assessment.

You might want to include some of the following
in your email. You may want to copy the email to your MP
and ask why the DWP does not enforce the Contract between the
DWP and Atos.

The key question as I see the matter is as follows.

Given the ESA information supplied.
Please can Atos supply the medical reasons in writing
why "Further Medical Evidence" is not required in deciding whether
a face to face assessment is necessary and if an assessment is necessary
why "Further Medical Evidence" is not required for the assessment.
You would like to see if the GMC agrees with the Atos medical reasons.

You could go into more details.

The ESA50 is a lay opinion of the patient's medical condition and thus does not constitute
medical evidence. A medical advisor is required in those medical conditions listed.
"Further Medical Evidence"
means medical evidence obtained from a third party such as, but not exclusively,
a general practitioner or a hospital practitioner and includes, but is not limited to,
written factual reports, hospital case notes including radiological and pathological
investigations.
SCHEDULE 4 SECTION 4.1 PART 2
4.5 Basis of Medical Advice
4.5.1 The CONTRACTOR shall ensure that wherever possible all medical reports and
medical advice:
4.5.1.1 is evidence based, that is, there is a consensus of critically evaluated,
published medical evidence in support of the advice provided by the
CONTRACTOR;
4.5.1.5 is based only on documents that are consistent with one another as to
the evidence they contain;
4.5.1.7 takes full account of and records the effects of pain, fatigue and
medication on the Claimant's functional capacity or care needs;
4.19.1 When obtaining Further Medical Evidence, the CONTRACTOR shall make it clear to
the author of that evidence that all evidence may be given to the Claimant and that
the only information that can legally be withheld from the Claimant is that which may
be harmful to the Claimant's health.
11.1 The CONTRACTOR shall, within twenty four (24) hours of completion of their required action,
use reasonable endeavours to despatch to the AUTHORITY all required documentation,
including all Referral documentation, any Further Medical Evidence gathered and the
appropriate output form(s), unless specifically requested to dispose of any documentation by
the AUTHORITY.
Atos confirms that my medical assessment was unsound.
(http://www.whywaitforever.com/dwpatosletters.html#AH20100108F)
Dr Bruecker has advised that the pathology of your condition is not clear
from the available evidence and in order to establish whether your case falls
within the support group he has arranged for a request to be issued to your GP
to provide further information.
Our National Customer Relations Manager, Mr Pepper, has provided his comments
in response to the other numbered points you have raised:
1. He confirms that an assessment of capacity was undertaken which is different
to a diagnostic consultation. There is no requirement to have NHS medical
records available for the assessment. When it is considered appropriate by
the Healthcare Professional (HCP), further medical evidence can be requested
from the customer's medical carers.
Atos confirms to the HSE what an assessment comprises of.
(http://www.whywaitforever.com/dwpatoslettersgov.html#HSE20090929F)
The Centre assesses people's functional ability through consultation, discussion
and simple physical tests (e.g. reflex).
Thus if "consultation, discussion and simple physical tests" alone is insufficient
to provide "sound" medical advice "Further Medical Evidence" is required
as defined in the contract (as above).
Letter from the Right Honourable Jonathan Shaw MP, Minister for Disabled People
http://www.whywaitforever.com/dwpatoslettersgov.html#MIN20091028F
... may be pleased to learn that we already screen the information provided by
customers before deciding whether a face to face examination is required.
The precise circumstances for exemption are prescribed in the regulations and
include terminally ill people who are fast-tracked onto the higher rate of benefit.
Every effort is made to identify potentially exempt cases by liaising with the GP
or specialist before contacting the claimant. This ensures that where at all possible,
severely ill people are not troubled by the assessment and in particular do not
have to undergo a medical examination unnecessarily.

This approach has some successes. This is a comment from "Josie" on the
the Fibro Myalgia forum. This lady, like I, knew that a patient
in a medical should be seen by an expert in the condition with
full access to the medical history.

Had a appointment some time ago for a home visit for a medical and the doctor rang
me on route to ask if he could come earlier, I asked him on phone if he had knowledge
of my medical condition and he told me he had no knowledge, he said he would refer it
back to them.

Got appointment for this morning between 9am and 10.30am and he turned up late, 10.40,
came in and sat down, explained that he would ask me some questions and then do a medical,
I asked him if he had knowledge of condition and he said no. He then looked at notes
and said they should of sent some one with knowledge and said he would refer it back
and get a doctor with knowledge to attend otherwise I would not be having a fair assessment.

How can the Department for Work and Pensions give you a fair assessment when they have
no knowledge of the condition, that's crazy, they are meant to have knowledge of
chronic conditions and he had no knowledge, I now have to wait for a third appointment.
Has anyone else had this type of service from them and I won an appeal for
DLA for personal care and passed my medical with 15 points on the grounds
of having this condition, its crazy they don't use commonsense, you might
say that the rules for Incapacity Benefit are different but I passed with 15 points
on the grounds of having this condition so why do I have to see a doctor at home
who has no knowledge and wants to do a medical. Its crazy.

Breaches of Contract

My case provides the following examples of Atos Healthcare being
in breach of Contract.

The Minister was assured by Atos Healthcare
that a qualified healthcare professional reviewed the information
provided prior to deciding that a face to face meeting was necessary.
Initially I was told that a a nurse or midwife reviewed the information.
The "Atos" Independent Tier could not identify who made the decision.
A medical advisor did not review the information.
No qualified medical advisor reviewed the information provided
prior to the decision that a face to face meeting was necessary.

As I have cancer, a medical advisor must be a GMC registered doctor.
Because I have a primary brain tumour, the medical advisor should have
specialist neuro-science and neurology knowledge or should have contacted
my GP and or consultant.

Breach of the Contract - Appendix 1 of Schedule 4 Section 4.12 Final Version -
15 March 2005

This lists cancer as a medical condition that must be referred to
a Medical Advisor (GMC registered) for advice. The breach of contract
has been confirmed by Atos doctor Dr Bruecker and by the "Atos" Independent
Tier.

The medical assessment should not have taken place.
The appointments clerk despite being asked to consider the medical
situation refused to do so.
If a medical assessment were to have taken place, after taking advice
from my GP and Consultants,
it should have been carried out by a medical advisor with
specialist neuro-science and neurology knowledge.

Breach of the Contract - Appendix 1 of Schedule 4 Section 4.12 Final Version -
15 March 2005

This lists cancer as a medical condition that must be referred to
a Medical Advisor (GMC registered) for advice. The breach of contract
has been confirmed by Atos doctor Dr Bruecker and by the "Atos" Independent
Tier.

The quality of the medical report in respect of the standard
of written English is below the standard required in the Contract.

4.3.2 For the avoidance of doubt the main types of complaint that are included in this
category shall include but will be not be limited to:

b) injury as a consequence of examination

The medical assessment journey time exceeded the ninety minutes
maximum allowed in the Contract.

Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version -
15 March 2005

5.5 The CONTRACTOR shall ensure that any Claimant is not required to travel for more than
ninety (90) minutes by public transport (single journey) for an examination, ...

A forty minute waiting time exceeds the ten minutes
maximum allowed in the Contract.

Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version -
15 March 2005

5.7 The CONTRACTOR shall use reasonable endeavour to ensure that examinations
commence within ten (10) minutes, of their scheduled time, when Claimants arrive in time for
their appointment.

The advice given by Atos Healthcare to the DWP was a defamation
in writing and as such constituted a libel.

The libel was that I should receive the Employment and Support Allowance
and that I should be placed in a "Work Related Support Group" and in consequence
I am able to attend further face to face meetings.
Atos Healthcare at the time did not admit that the medical assessment was
invalid. I am pleased to note that at long last Atos Healthcare
has admitted that both the original review of the information provided
and the medical assessment were invalid.

The libel by Atos Healthcare caused the DWP to attempt to take action that
may have caused further injury to my person as the DWP was obliged to require
additional face to face meetings.

The months of delay in providing a copy of the
medical contract exceeds the period set in the Contract.

Many complaints were not acknowledged within the
two days maximum allowed in the Contract.

Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version -
15 March 2005

4.2.1 The CONTRACTOR shall acknowledge all complaints received directly from
Claimants or their representatives within two (2) Working Days.

Many complaints were not resolved within the
twenty days maximum allowed in the Contract.

Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version -
15 March 2005

4.2.2 The CONTRACTOR shall provide a full response to each Claimant or their
representative within the required turnaround times as set out in Schedule 5 of this
Agreement. This schedule defines the time as twenty (20) working days.

Customer relations refused to action a number of requests
made by email. The Contract specifically lists email as an
acceptable means of communications.

Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version -
15 March 2005

3.2.2 The CONTRACTOR shall ensure enquiries are accepted in any reasonable format,
(e.g. by telephone, in writing, by facimile or e-mail) ...

Referral to the Independent Tier was not made
in the time periods allowed in the Contract.

The Independent Tier operational details are not
specified in the Contract but are covered by general clauses
that require Atos Healthcare to comply with DWP procedures.
Recently the NAO has defined for the DWP what should constitute
an Independent Tier process. Once again Atos Healthcare have not
acknowledged that they have been informed of this within the
two days allowed in the Contract.

Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version -
15 March 2005

See following section and the National Audit Office (NAO) procedure.

The Independent Tier

The Contract between the DWP and Atos Healthcare, Schedule 4 Section 4.1
PART 1 Final Version dated 15 March 2005 page 6 of 15 contains the following:

4.1.7 The CONTRACTOR shall ensure that its complaints procedure includes
reference to and details of, a process that will give the Claimant or
their representative the right to seek an independent review, by an
independent tier, of their complaint should normal procedures not result
in a satisfactory resolution.

4.6 Independent Tier

4.6.1 The CONTRACTOR shall implement a revised independent tier for complaints as
agreed with the AUTHORITY.

The NAO (http://www.nao.org.uk/)
published a document dated 23 July 2008 for compliance by the DWP
(which covers the activities of Atos Healthcare).
This procedure provides recommendations on the requirements that
relate to the Independent Tier.

6. Since we last reported, the Department has made significant improvements to its
complaints handling. It has extended the remit of the
Independent Case Examiner
(http://www.ind-case-exam.org.uk/)
as an additional, independent tier through which customers can seek redress for
complaints. In parallel it has clarified its three-tiered complaints resolution
process and has made efforts to direct customers more clearly through this process.
The Department is also taking steps to embed the Parliamentary and Health Service
Ombudsman good practice principles across all the Agencies.

If you review the correspondence you may get the impression that
Atos Healthcare is reluctant to follow the NAO procedure.
It is hard to understanding the reasoning behind not using the agreed
independent tier procedure for a procedure in which the party at fault
makes decisions as to the procedure to be followed and selects the individuals
who are to decide what matter is to be considered and how to weight that matter.